Provider Demographics
NPI:1922022375
Name:YEUNG, OMAR KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:KENNETH
Last Name:YEUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22117 GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1249
Mailing Address - Country:US
Mailing Address - Phone:708-747-6610
Mailing Address - Fax:708-747-6703
Practice Address - Street 1:22117 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1249
Practice Address - Country:US
Practice Address - Phone:708-747-6610
Practice Address - Fax:708-747-6703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019217901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice